Vaginal Birth After Cesarean (VBAC)
What birth options do I have after a caesarean birth?
In the UK, more than 1 in 5 women (20–30%) give birth by caesarean section.
Many women also give birth by caesarean section in their subsequent deliveries.
If you have already had one or more caesarean births (CS), you may be thinking about the birth options available to you next time.
Whether you choose a vaginal birth or another caesarean section in a future pregnancy, your choice will be safe, with different risks and benefits depending on the circumstances.
In general, both options are safe, with minimal risk.
When the time comes to decide, we will discuss your medical history and the details of your previous pregnancies. It is important to know:
the reason why the caesarean section was performed and exactly what happened – e.g., was it an emergency CS?
the type of incision that was made on your uterus?
how you feel about your previous caesarean? Do you have any concerns about how things progressed?
whether your current pregnancy has been straightforward from the outset and without problems, or whether there have been complications?
You will discuss with us the likelihood of a successful vaginal birth, your personal preference, as well as your future family plans, before making a decision about a vaginal birth or another caesarean section.
Many women also give birth by caesarean section in their subsequent deliveries.
If you have already had one or more caesarean births (CS), you may be thinking about the birth options available to you next time.
Whether you choose a vaginal birth or another caesarean section in a future pregnancy, your choice will be safe, with different risks and benefits depending on the circumstances.
In general, both options are safe, with minimal risk.
When the time comes to decide, we will discuss your medical history and the details of your previous pregnancies. It is important to know:
the reason why the caesarean section was performed and exactly what happened – e.g., was it an emergency CS?
the type of incision that was made on your uterus?
how you feel about your previous caesarean? Do you have any concerns about how things progressed?
whether your current pregnancy has been straightforward from the outset and without problems, or whether there have been complications?
You will discuss with us the likelihood of a successful vaginal birth, your personal preference, as well as your future family plans, before making a decision about a vaginal birth or another caesarean section.
What does VBAC mean?
VBAC stands for Vaginal Birth After Caesarean and means “Vaginal Birth After Caesarean.” It is the medical term used when a woman gives birth vaginally (i.e., normally) after having had at least one caesarean section in the past. Vaginal birth also includes assisted vaginal delivery with forceps or a vacuum (ventouse).
What does a planned caesarean mean?
The date for a planned caesarean is arranged by your obstetrician during your antenatal care. It is usually scheduled in the last weeks before your expected due date, unless there is a reason to bring the birth forward either for you or for your baby.
What are the benefits of a successful Vaginal Birth After Caesarean (VBAC)?
The benefits of a successful vaginal birth after caesarean are as follows:
- a greater likelihood of an uncomplicated vaginal birth in future pregnancies.
- faster recovery and a shorter stay in the maternity unit.
- less abdominal pain after birth.
- you will not have undergone surgery, thereby avoiding its potential complications.
What are the chances of success for a Vaginal Birth After Caesarean (VBAC)?
In the UK, overall, three out of four women (75%) with a straightforward, uncomplicated pregnancy who have had a caesarean section in the past give birth vaginally.
Among those who have already had a vaginal birth, either before or after the caesarean section, 9 out of 10 (90%) give birth vaginally again.
Most women with two previous caesarean sections have their next baby by caesarean section as well. However, if they choose a vaginal birth next time, the chances of success are only slightly lower than the above (between 70% and 75%). The likelihood of complications increases in this case.
Among those who have already had a vaginal birth, either before or after the caesarean section, 9 out of 10 (90%) give birth vaginally again.
Most women with two previous caesarean sections have their next baby by caesarean section as well. However, if they choose a vaginal birth next time, the chances of success are only slightly lower than the above (between 70% and 75%). The likelihood of complications increases in this case.
What are my chances of success for a Vaginal Birth After Caesarean (VBAC)?
There are a number of factors (risk factors) that reduce the chances of a successful vaginal birth. These are:
- you have never had a vaginal birth before.
- you need labour to be induced.
- the baby is not in a good position and you therefore need a caesarean section.
- you are overweight – with a body mass index (BMI) over 30 when you became pregnant.
What are the disadvantages of a Vaginal Birth After Caesarean?
The disadvantages of a vaginal birth after caesarean include the following:
- Emergency caesarean section
There is a chance you may need an emergency caesarean during labour. This happens in about 25 women out of 100 (25%). This rate is slightly higher than the corresponding rate for first-time mothers, which is around 20% (20 out of 100 first-time mothers need an emergency caesarean). An emergency caesarean is usually performed if labour slows down or if there is concern about the wellbeing of the baby or the mother.
- Blood transfusion and uterine infection
Women who choose to give birth vaginally after a caesarean have a 1% higher chance of needing a blood transfusion or developing a uterine infection compared with women who choose a planned caesarean section.
- Thinning or rupture of the scar from the previous caesarean
There is a possibility that the uterine scar may weaken or even open during vaginal birth. If it opens completely (rupture), this can have serious consequences for the woman and the baby. The risk of this is very small, as it occurs in only 0.5% of cases. The rate increases if labour needs to be induced. If there are signs of this, the baby will be delivered by emergency caesarean section.
- Risks for the baby
The risk of brain injury or death of the baby in a vaginal birth after caesarean (two in 1,000 women or 0.2%) is not higher than the risk when a woman gives birth for the first time. However, it is slightly higher than the risk if the woman chose a planned caesarean (one in 1,000 or 0.1%).
All of the above, of course, is balanced against the corresponding risks associated with choosing another planned caesarean (see below).
When is Vaginal Birth After Caesarean (VBAC) not recommended?
The situations in which vaginal birth after caesarean is not recommended and a planned caesarean is preferable are the following:
- if you have had three or more previous caesarean births
- if you have had a uterine rupture in a previous birth
- if you have a high uterine incision (classical caesarean section)
- if you have other complications in pregnancy that require a caesarean section.
What are the advantages of a planned caesarean?
The advantages of a planned caesarean are as follows:
- there is essentially no risk of the uterine scar opening
- the risks of labour are avoided, especially the risk of brain injury or stillbirth due to lack of oxygen during labour (0.1%)
- you know the exact date of birth.
However, since the caesarean is scheduled within the final week before the expected due date, there is a chance you may go into labour before the planned caesarean date. One in ten women (10%) give birth before that date.
What are the disadvantages of a planned caesarean?
The disadvantages of a planned caesarean are as follows:
- Longer duration and potentially more difficult surgery
A planned caesarean section after a previous caesarean birth usually takes longer than the first operation due to scar tissue and adhesions. Adhesions may also make the operation more difficult, and surgical handling may cause injury to the bowel or the bladder. There are rare reports of injury to the baby due to carelessness.
- Risk of a blood clot (thrombosis)
A blood clot that forms in the lung is called a pulmonary embolism. Pulmonary embolism can be life-threatening for a woman (rate lower than 1 in 1,000 caesareans, due to the use of anticoagulant injections).
- Slower recovery
You may need more help at home and you may not be able to drive for about six weeks after giving birth.
- Breathing problems in the baby
Breathing problems in a newborn are fairly common after a caesarean, but they usually do not last long. Sometimes the baby needs to be admitted to the maternity unit’s neonatal intensive care/special care baby unit. Three to four babies out of 100 (3–4%) born by planned caesarean have breathing problems, compared with two to three out of 100 (2–3%) born by vaginal birth after caesarean. The risk is minimised if the caesarean is performed in the final week of pregnancy and not earlier.
- Need to repeat planned caesarean in future pregnancies
After each caesarean, there is more scar tissue and adhesions in the uterine wall. This increases the chance that, in a future pregnancy, the placenta will develop within this tissue, making it difficult to remove during the caesarean (placenta accreta). This can cause bleeding and, rarely, may need to be managed with a hysterectomy. All of these serious risks increase after each birth delivered by caesarean section.
What will happen when it is time to give birth if I have chosen “Vaginal Birth After Caesarean (VBAC)”?
You should contact us as soon as you realise that labour is starting or if your waters break. In the delivery room, both your heart rate and the baby’s heart rate will be monitored continuously. You can have an epidural if you wish.
What happens if I have not given birth by my due date and I have chosen Vaginal Birth After Caesarean (VBAC)?
If labour has not started and you have already reached 40 weeks of pregnancy, you have several options, which we will discuss at the clinic. These are:
- you continue to wait for one more week, until labour starts naturally.
- labour is induced. This increases the risk of weakening of the scar and reduces the chances of a successful Vaginal Birth After Caesarean.
- you decide on a new planned caesarean. Some women choose Vaginal Birth After Caesarean when labour starts naturally, but if the due date passes, they prefer a planned caesarean rather than induction of labour.
What if I have chosen a planned caesarean and labour suddenly starts?
We will contact you so you can describe what is happening (whether you are having contractions or your waters have broken). Most likely, an emergency caesarean will be performed if it is confirmed that labour has started. If labour is already very advanced or if the birth is preterm (before 37 weeks), then Vaginal Birth After Caesarean VBAC may be more appropriate.
